Elsevier

Journal of Vascular Surgery

Volume 1, Issue 6, November 1984, Pages 867-876
Journal of Vascular Surgery

Society for Vascular Surgery: Original Articles
Thrombectomy with temporary arteriovenous fistula: The treatment of choice in acute iliofemoral venous thrombosis*,**

Presented at the Thirty-eighth Annual Meeting of the Society for Vascular Surgery, Atlanta, Ga., June 7-8, 1984.
https://doi.org/10.1016/0741-5214(84)90019-3Get rights and content

Abstract

The treatment of choice in acute iliofemoral venous thrombosis is still controversial. This prospective randomized study compares the results of conventional anticoagulation of 32 patients with the results obtained in 31 patients undergoing acute thrombectomy combined with a temporary arteriovenous fistula and anticoagulation. Early complications were few in both treatment groups, and significant pulmonary embolism developed in only one conservatively treated patient. At 6-month follow-up in all surviving patients, leg swelling, varicose veins, and venous claudication were more frequent after conservative treatment. Only 7% (2 of 27) of these patients were completely free from postthrombotic symptoms compared with 42% (10 of 24) of the operated patients (p < 0.005). Contrast phlebography demonstrated an excellent venous outflow through the iliofemoral segment in 35% (9 of 26) of the conservatively treated and in 76% (16 of 21) of the operated patients (p < 0.025). Open femoropopliteal veins with competent valves were recorded in 26% (7 of 27) in the conservative group and in 52% (12 of 23) in the thrombectomy group (p < 0.05). Thus thrombectomy combined with arteriovenous fistula decreases early symptoms and preserves venous outflow and valvular function better than conservative treatment. This procedure is therefore recommended for young patients with acute iliofemoral thrombosis to avoid development of incapacitating postthrombotic sequelae. (J VASC SURG 1984;1:867-876.)

Section snippets

Material and methods

From July 1, 1979, to June 30, 1982, 63 patients admitted to Helsingborg County Hospital and to the University of Lund, Sweden, with acute iliofemoral venous thrombosis met the following criteria for inclusion into the present study:

  • 1.

    Deep venous thrombosis with proximal extension above inguinal ligament but below caval bifurcation

  • 2.

    Swelling of entire leg for less than 7 days

  • 3.

    Present pedal pulses

  • 4.

    Neither anticoagulation nor surgery contraindicated

  • 5.

    No history or sign of congestive heart failure

  • 6.

    No

Results

Both conservatively and surgically treated patients experienced a rapid decrease in leg swelling. The difference in calf circumference when comparing the two legs decreased during the first week from 4.3 ± 2.0 cm (mean ± SD) to 2.6 ± 1.8 cm in the conservative group and from 3.8 ± 2.2 to 2.0 ± 1.8 cm in the surgical group. The hospital stay ranged from 5 to 23 days (median 9 days) in the conservative group and 7 to 35 days (median 11 days) in the surgical group.

Early complications were

Discussion

Acute deep venous thrombosis is treated conservatively in most institutions. Previous reports of anticoagulation treatment in acute iliofemoral thrombosis have demonstrated that initial lysis is rare.2, 10, 17, 28 The incidence of recanalization of the iliofemoral segment, development of sufficient collateral flow, and preservation of femoropopliteal valvular competence after conservatively treated iliofemoral thrombosis is not well known because of a low incidence of follow-up phlebography in

References (45)

  • WH Edwards et al.

    Iliofemoral venous thrombosis: Reappraisal of thrombectomy

    Ann Surg

    (1970)
  • RL Kistner et al.

    Surgery in acute and chronic venous disease

    Surgery

    (1979)
  • LK Widmer et al.

    Heparin oder Thrombolyse in der Behandlung der tiefen Beinvenenthrombose

    Vasa

    (1974)
  • A Andriopoulos et al.

    Results of iliofemoral venous thrombectomy after acute thrombosis. Report of 165 cases

    J Cardiovasc Surg

    (1982)
  • S Horsch et al.

    Chirurgische Behandlung der akuten Bein-und Beckenvenenthrombose

    Med Klin

    (1979)
  • J Matsubara et al.

    Treatment of iliofemoral venous occlusion

    J Cardiovasc Surg

    (1982)
  • GE Mavor et al.

    Iliofemoral venous thrombosis. Pathological considerations and surgical management

    Brit J Surg

    (1969)
  • U Brunner et al.

    Spatresultate nach Thrombektomie bei Iliofemoralvenenthrombose im klinisch-radiologischen Vergleich

    Schweiz Med Wochenschr

    (1971)
  • MS Elliot et al.

    A comparative randomized trial of heparin versus streptokinase in the treatment of acute proximal venous thrombosis: An interim report of a prospective trial

    Br J Surg

    (1979)
  • H Goto et al.

    Iliofemoral venous thrombectomy. Follow-up studies of 88 patients

    J Cardiovasc Surg

    (1980)
  • AM Lansing et al.

    Five-year follow-up study of iliofemoral venous thrombectomy

    Ann Surg

    (1968)
  • G. Baumann

    Indikation, Technik und Ergebnisse der Thrombektomie

    Chirurg

    (1976)
  • Cited by (0)

    *

    Supported by The Thorsten and Elsa Segerfalk Foundation for Medical Research and Education and by The Salus' Fifty-Year Foundation for Medical Research.

    **

    Reprint requests: Gunnar Plate, M.D., Dept. of Surgery, Helsingborg County Hospital, S-25187 Helsingborg, Sweden.

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